Mental disorders and their comorbidities among children and adolescents aged 6 to 18 years in Lorestan Province

Objectives The profile of mental disorders has been changing over time. The aim of this study was to investigate the prevalence of mental disorders in children and adolescents in the Lorestan province of Iran. Materials & Methods This community-based cross-sectional study was done on 1001 children and adolescents aged 6-18 years from Lorestan province randomly selected by multistage cluster sampling method. Children and their parents were interviewed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). Also, the comorbidities of psychiatric disorders were evaluated. Results According to obtained results, 25.1% of participants were diagnosed to have at least one psychiatric disorder. The prevalence of psychiatric disorders was not significantly different between the two sexes (OR=0.876, P=0.378) and three age groups (P>0.05). this prevalence was significantly higher in rural areas than in urban areas (OR= 1.997, P=0) and was significantly lower in children of fathers with a high school diploma or higher education compared to children of less-educated fathers (P<0.05). On contrary, it was significantly more prevalent in children of mothers with high school and bachelor's degrees compared to illiterate mothers. (p<0.05). The most prevalent psychiatric disorders were oppositional defiant disorder (ODD) (5.9%), separation anxiety disorder (5.3%), and depressive disorders (5%). The most prevalent groups of psychiatric disorders included anxiety disorders (11.2%), behavioral disorders (9.4%), and mood disorders (5%). Behavioral disorders were highly comorbid with anxiety disorders (20.7%). Conclusion Mental disorders affect a high proportion of children and adolescents in Lorestan province. There is a need for psychiatric facilities to provide for the needs of families to child mental health services.


Introduction
The profile of psychiatric and mental disorders In a study on the prevalence of behavioral disorders among preschool children, it was indicated that of a total of 1977 cases, attention problem was the most common disorder among boys (6.1%), while emotional problems were the most common problem among preschool girls (17.2%) (2).
The results of a cross-sectional study on 1200 primary school students in Khorramabad, using a questionnaire for parents and teachers, showed a prevalence of 6.5% for ADHD (3). Another study on 945 primary school students using standard questionnaires reported the prevalence of 17.3% for ADHD (4).
All these studies have used standardized questionnaires for screening specific psychiatric disorders and have been carried out in the setting of schools of Khorramabad, the main city of the province; but no epidemiological studies are using structured interviews assessing all psychiatric and mental disorders in children and adolescents of the province, including rural areas. This is the first epidemiological study conducted in Lorestan province addressing the prevalence of different psychiatric disorders in children and adolescents.

Study Design
This survey was an analytical cross-sectional study and a part of the Epidemiology of Psychiatric Disorders in Iranian Children and Adolescents (IRCAP), which was performed in Lorestan Province. Details of the study design and procedure can be found in the protocol article published by Mohammadi et al. (5).

Sampling
A total of 1001 children and adolescents aged 6-18 years were selected randomly from Khoramabad, Lorestan, and some rural areas of the province by multistage cluster sampling method. One hundred and seventy cluster heads based on gender (boy/girl) and age (6-9 years, 10-14 years, and 15-18 years) blocks (6 samples in each) were randomly selected according to postal code. Cluster head selection from urban and rural areas was proportional to population.

Inclusion and Exclusion Criteria
Inclusion criteria were being a citizen of Lorestan province (at least one-year residence in the Lorestan province), and age range of 6 to18 years. The exclusion criterion was children and adolescents with severe physical illness.

Data Collection
The clinical psychologists participating in this study were instructed to complete the Persian

Results
We used descriptive analysis and a 95% confidence interval to determine the frequency of psychiatric disorders in children and adolescents. Logistic regression was used to calculate the odds ratios and test the significant differences of prevalence according to demographic variables as well as to control the confounding variables.
A total of 1001 children and adolescents (49.2% boys and 50.8% girls) were included in the analysis, of whom 25.1% were diagnosed with psychiatric disorders. The frequency of demographic variables in the samples and the prevalence of psychiatric disorders in terms of these variables are shown in Table 1. Table 2 shows the significance of the relationship between demographic variables and psychiatric disorders in the samples. The results showed that gender (p=0.025, 95%CI =.485-.952), and father's unemployment (p=0.016, 95%CI =1.262-9.620) had a significant correlation with the frequency of psychiatric disorders.
The prevalence rate of different types of psychiatric disorders is shown in Table 3. The prevalence of specific psychiatric disorders and classes of disorders are shown in Figures 1 and 2, respectively. Table 4 shows comorbidity disorders according to the type of psychiatric disorders in the province.      procedures, and study quality (12).

P O S T -T R A U M A T I C S T R E S S D I S O R D E R M E N T A L R E T A R D A T I O N C O N D U C T D I S O R D E R A G O R A P H O B I A O B S E S S I V E C O M P U L S I V E D I S O R D E R T O B A C C O U S E S P E C I F I C P H O B I A S G E N E R A L I Z E D A N X I E T Y S O C I A L P H O B I A E P I L E P S Y A T T E N T I O N D E F I C I T H Y P E R A C T I V I T Y D I S O R D E R E N U R E S I S D E P R E S S I V E D I S O R D E R S S E P A R A T I O N A N X I E T Y D I S O R D E R O P P O S I T I O N A L D E F I A N T D I S O R D E R
The results showed no difference in the overall prevalence of psychiatric disorders between boys and girls. In a study by Alavi et al. on the prevalence of psychiatric problems in children aged 6 to 11 years in Tehran, the overall prevalence was reported to be 17.9, and no significant difference was observed between the two genders; however, bedwetting in boys and anorexia nervosa in girls were reported more than the other sex (13).
The rate of psychiatric disorders in rural areas was estimated to be significantly higher compared to urban areas; but in other studies, the rates of most types of psychiatric disorders in urban areas are estimated to be higher compared to rural areas (14).
However, a recent study showed that the difference was not statistically significant (15). Other factors related to the place of residence, such as poverty, unemployment, and lower socioeconomic status should also be considered (16).
The results also showed that psychiatric disorders

In Conclusion
Psychiatric disorders affect a high proportion of children and adolescents in Lorestan province.
There is a need for more public education and modification of psychiatric facilities to provide the needs of families and psychiatric services.